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Litt’s
Drug
14th Edition
L i t t ’s
Eruption
Drug
Reference Manual
Including Drug Interactions
14th Edition
L i t t ’s
By Jerome Z. Litt, MD
Eruption
Drug Eruption
Reference Manual
Including Drug Interactions
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
14th Edition
authoritative guide to all the known adverse effects from newly approved as well as
commonly prescribed and over-the-counter drugs, herbals and supplements. The easy-to-
use format and wealth of information make this book an essential and invaluable tool for
every dermatologist and general practitioner.
Jerome Z. Litt MD
‘There is no comparable reference.’ Michael Borts M.D, USA
‘It’s the best way to determine which drug is probably causing the reaction.’ Sophia J Hendrick,
Pediatric Dermatologist, USA
‘Can’t do hospital consultations without it.’ George B Winton, Dermatologist, USA
‘Website is great. Everyone should arrange access to it.’ Dr L J Cook, Consultant Dermatologist, UK
‘I cannot start my day without it.’ Benjamin B Bince, Chief of Dermatology, Philippines
‘I love it. Indispensable for the dermatologist.’ Daniel M Siegel, Clinical Professor of Dermatology, USA
‘This is an INVALUABLE tool. I love it. We actually all signed a petition to make sure our library
keeps it.’ Kavita Mariwalla, Chief Resident, USA
‘The best reference for skin reactions.’ Simon Cooper, Associate Specialist, UK
Jerome Z. Litt MD
www.informahealthcare.com
©2008 Informa UK Limited
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any
form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms
of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road,
London W1P 0LP.
Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this
publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our
attention.
Although every effort has been made to ensure that drug doses and other information are presented accurately in this
publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can
be held responsible for errors or for any consequences arising from the use of information contained herein. For
detailed prescribing information or instructions on the use of any product or procedure discussed herein, please
consult the prescribing information or instructional material issued by the manufacturer.
A CIP record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Data available on application
ISBN-10 0415458854
ISBN-13 9780415458856
Introduction vii
v
To Vel – my Muse
INTRODUCTION
Any drug can cause any rash. The terms ‘drug allergy,’ ‘drug hypersensitivity,’ and ‘drug
An adverse drug reaction (ADR) – or an adverse drug reaction’ are often used interchangeably. Drug allergy is
event (ADE) – describes any unwanted, unpleasant, noxious, restricted specifically to a reaction mediated by IgE; drug
or harmful consequence associated with the use of medica- hypersensitivity is an immune-mediated response to a drug
tions that have been administered in standard doses by the agent in a sensitized patient; and drug reactions comprise all
proper route for the purposes of prophylaxis, diagnosis, or adverse events related to drug administration, regardless of
treatment. This definition does not include abuse, overdose, etiology.
withdrawal, or error of administration. It appears that most Adverse drug reactions have been arbitrarily classified
ADRs are related to the dose. Death is the ultimate adverse into six types:
drug event.
1. Dose-related (e.g. Digoxin toxicity)
ADRs, major problems in drug therapy, are a few of the
2. Non-dose-related (e.g. Immunological reactions)
leading causes of morbidity and mortality in health care and
3. Dose-related and Time-related (e.g. Corticosteroids)
they should be considered in the differential diagnosis of a
4. Time-related (e.g. Tardive dyskinesia)
wide variety of medical disorders.
5. Withdrawal (e.g. Opiate or beta-blocker withdrawal)
More and more people – primarily the older population –
6. Unexpected failure of therapy (e.g. Inadequate dosage
are taking more and more prescription and over-the-coun-
of an oral contraceptive)
ter medications. New drugs are appearing in the medical
marketplace on an almost daily basis. More and more drug Physicians in all specialties are often perplexed by the nature
reactions – in the form of cutaneous eruptions – are devel- of some of these problems. The few sources that are avail-
oping from all drugs. It has been reported that more than able to identify the causes of many of these side effects can-
100,000 hospitalized people in the United States alone died not be accessed by proprietary (Trade, Brand) names.
in 1999 as a result of medications. This Manual is a Drug Eruption Reference guide that
While most adverse drug reactions are relatively mild, and describes and catalogues the adverse cutaneous side effects
many disappear when the drug is either stopped or when the of more than 1000 commonly prescribed and over-the-
dose has changed, other adverse drug reactions are often counter generic drugs (more than 50 of which are new to
more serious and longer lasting. Cutaneous drug eruptions this edition). All drugs have been listed and indexed by both
can mimic almost any inflammatory dermatosis. While most their Generic and Trade (Brand) names for easy accessi-
eruptions are mild and self-limited, severe and life-threaten- bility.
ing eruptions do occur, as seen with the Stevens-Johnson As a result of space constraints, several of the Generic
syndrome and toxic epidermal necrolysis. drugs from earlier editions have been extirpated either
About five percent of hospital admissions in the United because they have been withdrawn from the marketplace or
States are estimated to be for treatment of adverse drug that they are rarely if ever prescribed now. These, please
reactions. Also, each time a person is hospitalized, the risk of note, are still available – and always will be – on the website –
having at least one adverse drug reaction is about fifteen per- www.drugeruptiondata.com.
cent; and as many as one-third of all emergency department In addition to adverse cutaneous reactions, there are
and urgent care center visits are drug related. many severe, hazardous interactions that are known to
ADRs are underreported and thus are an underestimated occur between two or more drugs. I have incorporated only
cause of morbidity and mortality. The incidence and severity the highly, clinically significant drug interactions that can trig-
of ADRs can be influenced by patient-related specific factors: ger potential harm, and that could be life-threatening. These
age, sex, disease, genetic factors, geographic factors, and by interactions are predictable and well documented in con-
drug-related factors: type of drug, route of administration trolled studies; they should be avoided. This subdivision
(intramuscular, intravenous and topical administrations are denoting hazardous interactions has been omitted from
more likely to cause hypersensitivity reactions; oral medica- those drugs where no such interactions have been reported.
tions are less likely to result in drug hypersensitivity), dura- For each drug, I have listed all the known adverse side
tion of therapy, dosage, and bioavailability, as well as by effects – in the form of drug reactions – that can result from
interactions with other drugs. More drugs – and more com- the use of the matching drug.
binations of drugs – are being used to treat patients than ever Appropriate references (author, journal or book, volume,
before, and it has been estimated that fatal ADRs are the date and page) for each side effect of every drug have been
third or fourth leading cause of death in the US. cited. Where there is more than one reference to a specific
vii
INTRODUCTION
side effect, I have employed the most illustrative and most Reactions: These are the Adverse Reactions to the
recent citation(s) in the literature. particular Generic drug. They are classified in six Catego-
In this new, 2008 state-of-the-art fourteenth edition, I ries: Skin, Musocal, Hair, Nails, Eyes, and Other.
have cited more than 30,000 references and sources from (Other refers to Mucous Membrane, Teeth, Muscle and
journals articles, books and observations as well as from der- various other forms of Reactions.) Reactions are listed
matologists from all over the world via the Internet and from alphabetically in each Category.
personal communications. This Manual includes all refer- Under each Reaction Pattern are listed the References
ences, 28,367, from 1980 until October, 2007. The com- (the sources of the information). These are arranged in
plete number, 39,599, of references, as far back as 1922, can reverse chronological order – the most recent reference
be found on the website, (www.drugeruptiondata.com) appearing first on the list.
The first part of the Manual lists, in alphabetical order, all References in the English language predominate. For the
the listed 1,195 Generic drugs and over 6,000 Trade few foreign references, we have resorted to the summary or
name drugs with their corresponding names for easy access abstract. The majority of the citations come from the J Am
to the A-Z section – the main body of the Manual. Acad Dermatol, Arch Dermatol, Cutis, Int J Dermatol, Contact
Next comes a listing of the various Classes of drugs, and Dermatitis, Br J Dermatol, JAMA, Lancet, BMJ, Aust J Dermatol,
those Generic drugs that belong to each class. N Engl J Med, Ann Intern Med, and other prominent and easily
The major portion of the Manual – the body of the work – accessible journals.
lists the 1,195 Generic drugs, herbals and supplements in As a function of space limitations, the list of References
alphabetical order and the adverse reactions that can arise has been restricted mainly to those after 1980. Please
from their use along with the appropriate references. note, however, that all References going as far back as
The last parts of the Manual include a description of the 34 1922 can still be accessed on our website – www.
most common Reaction Patterns; a listing of those drugs drugeruptiondata.com.
that can occasion more than 100 different reaction patterns, Many reference works have been consulted in the course
including, among others, Acne, Acute generalized of compiling this Manual. These include:
exanthematous pustulosis, Alopecia, Aphthous
(2002): Stockley IH, STOCKLEYS DRUG
stomatitis, Bullous eruptions, Bullous pemphigoid,
INTERACTIONS, Pharmaceutical Press, London and
Erythema multiforme, Erythema nodosum,
Chicago
Exanthems, Exfoliative dermatitis, Fixed eruptions,
Lichenoid eruptions, Lupus erythematosus, (1998): Kauppinen K et al, SKIN REACTIONS TO
Onycholysis, Pemphigus, Photosensitivity, Pityriasis DRUGS, CRC Press, Boca Raton
rosea, Pruritus, Psoriasis, Purpura, Pustular erup-
(1996): Bruinsma W, A GUIDE TO DRUG
tions, Stevens-Johnson syndrome, Toxic epidermal
ERUPTIONS, The File of Medicines, PO Box 21, 1474
necrolysis, Urticaria, and Vasculitis.
HJ Oosthuizen, Netherlands.
(1994): Goldstein S & Wintroub BU, ADVERSE
USAGE, STYLE & CONVENTIONS EMPLOYED IN
CUTANEOUS REACTIONS TO MEDICATION,
THIS MANUAL
CoMedica, New York.
The Generic Drug name is at the top of each page.
(1992): Zürcher K & Krebs A, CUTANEOUS DRUG
A category for Synonyms (where applicable) follows.
REACTIONS, Karger, Basel.
The Trade (Brand) Name(s) are then listed alphabeti-
cally. When there are many Trade Names, the ten (or so) (1992): Breathnach SM & Hintner H, ADVERSE DRUG
most commonly recognized ones are listed. This compilation REACTIONS and the SKIN, Blackwell, Oxford.
lists and cross-references both the Trade and Generic
(1988): Bork K, CUTANEOUS SIDE EFFECTS OF
names of all the cataloged drugs. Following the more com-
DRUGS, WB Saunders, Philadelphia.
mon Trade Name drugs are recorded – in parentheses –
the latest name of the pharmaceutical company that is mar- There are occasions when there are very few or no
keting the drug. As a result of acquisitions, mergers, and adverse reactions to a specific drug. These drugs are still
other factors in the pharmaceutical industry, many of the included in the Manual since there is often a positive signifi-
names of the companies have changed from earlier editions cance in negative findings.
of this Manual. As a departure from the official, conventional and estab-
Beneath the Trade Name listing is a list of Other Com- lished style guide, the order of each Reference will appear
mon Trade Names, those drugs from other countries. as follows:
Then appears the Indication(s), the Class in which the drug
• The year in parentheses. The most recent citation appears
belongs and the Half-Life of each drug, when known. On
first. This approach seems to be much more logical.
occasion, an important or pertinent Note will follow.
• Last name and initial(s) of the principal author.
viii
INTRODUCTION
• A plus sign (+) after the authors name represents one or There are occasional allusions to the incidence of many of
more co-authors. the listed Reactions. Percentages – which for the most part
are essentially vague and meaningless – are obtained from
• Journal name (standard abbreviation where possible), in
articles, from Zürcher & Krebs, and from Bork.
italics.
I have simplified the references to the many Reaction
• Volume Number (often followed by a parenthetical Part Patterns by eliminating, for the most part, tags such as ‘–
or Supplemental Number). like’ as in ‘–Psoriasis-like’ ‘–reactivation’ ‘–syndrome’ ‘–dis-
semination’ ‘–iform’, etc.
• First page of the article
Observation means just that. Observations (read:
• Books when cited are italicized, followed by the publisher Anecdotes) are derived from information obtained from
and page number. the Internet from more than 1,500 reliable dermatologists
from all over the world and from personal correspondence.
Other notes:
And if you send me your observations, they will be cataloged
• (sic) means just so. This is how the authors designated and you will be given appropriate attribution and recognition
the REACTION. in the next Edition.
• For example, Rash (sic); Dermatitis (sic); Skin Rash
Enjoy!
(sic)
Jerome Z. Litt, M.D.
• I have used the term passim to mean ‘in passing’. January, 2008
ix
INDEX OF GENERIC AND TRADE NAMES
xi
INDEX OF GENERIC AND TRADE NAMES
xii
INDEX OF GENERIC AND TRADE NAMES
xiii
INDEX OF GENERIC AND TRADE NAMES
xiv
INDEX OF GENERIC AND TRADE NAMES
xv
INDEX OF GENERIC AND TRADE NAMES
xvi
INDEX OF GENERIC AND TRADE NAMES
xvii
INDEX OF GENERIC AND TRADE NAMES
xviii
INDEX OF GENERIC AND TRADE NAMES
xix
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